Client Details

Name

First Last

Phone Number

Email Address

Rodent Details

Name

Species

Age (date of birth)

Sex

Is your rodent spayed or neutered?

Date acquired

Source (pet shop, friend, breeder, etc)

Details of Other Pets

Do you have any other rodents? If yes, please provide details (name, date acquired, source, any known illness)

Do you have any other pets? If yes, please provide details (species, date acquired, source, any known illness)

Husbandry

Does your rodent have access to the entire house? (If he/she is confined to one room, please provide details)

What is the temperature in your home?

Is the house centrally heated?

Are the windows in your home double-insulated?

Is your rodent kept in a cage indoors? If yes, please provide approximate dimensions

Please describe the bedding and litter used in the cage

Are there any smokers in the household?

Where does your rodent urinate and defecate?

Has your rodent damaged any household items? If yes, please provide details (item, how and when it was damaged)

Food

Please describe your rodent 's diet (Please list all the items that he/she is known to eat as well as the quantities of these items)

Where do you purchase your rodent's food?

Has there been a recent change in diet? If yes, please specify

Are any of the following given to your rodent?

Vitamins
Minerals
Medicines
Probiotics
Tonics

Water

Does your rodent drink from a bowl or a sipper-bottle?

How much water does your rodent drink each day?

Has the drinking increased or decreased as of late? If yes, when did you notice?

The Presenting Health Concern

Has your rodent had any previous health issues? If yes, please provide details

Please describe your rodent’s clinical symptoms

Does the skin and fur appear normal?

Has there been any excessive scratching?

Has there been any nasal or ocular discharge? If yes, please provide details

Has there been any odd positioning or loss of use of any limbs? If yes, please specify

Has there been any abnormal vocalization?

Are your rodent’s droppings normal in appearance and size? If not, please provide details

Have you noticed any coprophagy (rodent eats droppings)?

Any additional comments

Rodent Questionnaire

Client Details

Rodent Details

Details of Other Pets

Husbandry

Food

Water

The Presenting Health Concern

About Us

Regular Clinic Hours

Location

Directions